Credit Application Services Watchung - The Vantage Group Insurance Agency LLC

Personal Credit Application

Business Credit Application

Please choose application
- Main Application
- Co-Application
First Name:*
Last Name:*
Co-signer Name (if applicable):
Social Security:*
DOB:*
Address:*
Address:
City:*
State:*
Zip Code:*
Occupancy Type:
- Own
- Rent
- Finance
Other Occupancy Type:
Mortgage / Lien Holder:
Mortgage / Rent Sum Monthly:
Year at Address:
Email Address:*
Cell Phone Number:*
Home Phone Number:
Employer Information
Employer Name:
Job Title:
Annual Income:*
Work Address:*
Work Address:
Work City:*
Work State:*
Work Zip Code:*
Work Phone:
Length of Time at Occupation (Years & Months):
*
- I certify that the following information is valid and up-to-date; I permit my application to be processed and evaluated.
DELIVERY AUTHORIZATION:*
I agree to the delivery policy.
I hereby authorize THE VANTAGE GROUP NJ LLC and/or their directors, officers, employees, volunteers, representatives, vendors, and agents to pick up and deliver agreed upon vehicle to/from dealership to/from agreed upon location of delivery and assume all of the risk of having my vehicle delivered to the destination I selected. In consideration of the additional delivery fee that the company waived, in exchange for this release, and service provided, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: I waive, release, and discharge from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released and indemnify, hold harmless, and promise not to sue THE VANTAGE GROUP NJ LLC and/or their directors, officers, employees, volunteers, representatives, vendors, and agents, for any and all claims that relate to or arise out of delivering my vehicle from its current location to the destination of my choosing. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
Signature:*
Print Name
Date
Date Format: MM slash DD slash YYYY
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Business Name:*
Type of Business:
Federal Tax ID:*
Year Established:
Primary Phone Number:
Address:*
Address:*
Address:*
Address:*
Address:*
Email Address*
Your Relationship to the Company:
First Name:*
Last Name:*
SSN:*
Date of Birth:*
Date Format: MM slash DD slash YYYY
Time at Address (Year and Month):
Occupancy Type:
Mortgage Holder / Landlord:
Work Phone Number:*
Annual Income:*
*
- I certify that the following information is valid and up-to-date; I permit my application to be processed and evaluated.
Signature
Print Name:*
Date:*
Date Format: MM slash DD slash YYYY
Upload Your Licence:
Accepted file types: jpg, png, pdf, doc, gif, heic.
Upload Another Document
Accepted file types: jpg, png, pdf, doc, gif, heic.
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